抗N-甲基-D-天冬氨酸受体脑炎伴神经后遗症，对保守治疗无效，辅助治疗后完全缓解
Anti-NMDA receptor encephalitis with neurologic sequelae refractory to conservative therapy with complete response to adjuvant therapy.
作者信息
Nizam Aaron, Menzin Andrew W, Whyte Jill S
机构信息
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Northwell Health, Zucker School of Medicine at Hofstra/Northwell, Long Island, NY, USA.
出版信息
Gynecol Oncol Rep. 2020 Jun 3;33:100597. doi: 10.1016/j.gore.2020.100597. eCollection 2020 Aug.
BACKGROUND
Anti-N-methyl-D-aspartate (NMDA) receptor encephalitis has been described in increasing frequency in association with benign, mature ovarian teratoma. Affected patients typically present with paraneoplastic limbic encephalitis with flu-like symptoms followed by altered mental status, acute psychiatric symptoms, seizures and amnesia. These symptoms can rapidly progressive if not treated aggressively with surgical resection. Profound neurological symptoms may require immunotherapy.
CASE
We present a case of anti-NMDA receptor encephalitis associated with a malignant immature teratoma in which symptoms were refractory to surgical management and initial immunotherapy. A complete neurologic response was only seen after initiating adjuvant chemotherapy.
CONCLUSION
Anti-NMDA receptor encephalitis has rarely been described with immature ovarian teratomas. In these cases, a complete response may not be observed until systemic chemotherapy is started.
背景
抗N-甲基-D-天冬氨酸（NMDA）受体脑炎与良性成熟卵巢畸胎瘤相关的报道日益增多。受影响的患者通常表现为副肿瘤性边缘叶脑炎，伴有流感样症状，随后出现精神状态改变、急性精神症状、癫痫发作和失忆。如果不积极进行手术切除治疗，这些症状可能会迅速进展。严重的神经症状可能需要免疫治疗。
病例
我们报告一例与恶性未成熟畸胎瘤相关的抗NMDA受体脑炎病例，其症状对手术治疗和初始免疫治疗均无效。仅在开始辅助化疗后才出现完全的神经学反应。
结论
抗NMDA受体脑炎与未成熟卵巢畸胎瘤相关的情况很少见。在这些病例中，直到开始全身化疗才可能观察到完全缓解。
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